Care delivery · Neurodegenerative disease
Synapticure
A virtual specialty clinic for ALS, Parkinson’s and dementia, built by an ALS patient and his caregiver. Licensed in all 50 states, paid partly through a Medicare payment model that began in July 2024, and running a stem cell lab on federal grants.
The day they brought the baby home
In 2017 Brian Wallach and Sandra Abrevaya carried their newborn second daughter through the front door. That same day Wallach, then 37, learned he had ALS. He was given six months to live.
He was a federal prosecutor in Chicago and had worked in the Obama White House counsel’s office. She had worked in the House, the Senate and the White House. They met on the 2008 campaign. What they did next was the thing campaign people do: they built an organization, then another one. The second one bills insurance.
By 2023, Abrevaya told NPR, keeping Wallach alive and at home cost somewhere around $300,000 a year. Her point was not about her own family. “When people can’t afford that, their entire life is imprisonment,” she said.
The gap it is aimed at
Roughly 10 million Americans live with a neurodegenerative disease, and the specialists who treat them are scarce. MedCity News, reporting on the 2024 raise, noted that patients often wait six to nine months or longer for a neurology appointment. Nearly half of people with ALS live more than 50 miles from the nearest multidisciplinary clinic, by the company’s 2022 count.
Distance is what telemedicine is good at. The harder part is money. For most of the last decade there was no clean way to bill for the work that actually helps these families: the coordinator who finds the wheelchair vendor, the person who answers the phone at 2am, the respite hours that let a spouse sleep.
Then Medicare built one. The Guiding an Improved Dementia Experience model, GUIDE, started July 1, 2024. It pays a tiered monthly dementia care management fee per patient, adjusted on quality measures, plus up to $2,500 a year per patient for respite. CMS picked every participant in a single 2024 application window and closed the door for the model’s eight year run. Synapticure got in.
Two campaign operatives and a brother
The pair founded the nonprofit I AM ALS in January 2019. Its lobbying is credited with more than $1 billion in additional federal ALS funding and with the ACT for ALS law President Biden signed in December 2021. Wallach testified before Congress three times. As his voice failed, Abrevaya read his words for him.
Synapticure came out of the same frustration, aimed at a different target. It was co-founded with Wallach’s brother Peter, a former Bain consultant who became CFO, and with two people who had built health companies before: Jason Langheier of Foodsmart and Jonathan Hirsch of Syapse. GV led a $6 million seed that closed in early fall 2021 and was announced on February 1, 2022, alongside a New York Times feature. The clinical bench was heavy from the start: Jinsy Andrews as chief medical officer, Aaron Gitler of Stanford and Jeff Rothstein of Johns Hopkins advising, and named collaborations with the ALS clinics at Mass General and UCSF.
From one disease to five
ALS first, in 2022. Parkinson’s and Huntington’s by November of that year. All 50 state licenses in 2023, then cognitive care and behavioral health for patients and caregivers both. In April 2024 the ALS Association agreed to offer the platform alongside its certified treatment centers and to embed a patient liaison in the virtual clinic. In August 2024 Pearl Health began referring Medicare patients through GUIDE. That November, B Capital led a $25 million Series A that also drew CVS Health Ventures, Optum Ventures, CommonSpirit Health, RA Capital and Rock Health Capital. In July 2026 an ataxia program opened with Biogen supporting disease education around it.
Running underneath all of it is something odd for a telehealth company: a laboratory. Since 2022 NIH has given Synapticure five NINDS small business awards totaling $5,175,078 to build patient derived brain organoids for ALS and frontotemporal dementia drug screening.
What is proven, and what is still claimed
| Evidence | What the record shows | Source type |
|---|---|---|
| CMS GUIDE model terms | Began July 1, 2024. CMS pays a tiered monthly dementia care management fee per patient, adjusted on quality performance, plus up to $2,500 a year per patient for respite. Participants must staff care navigators and a 24/7 line. New enrollment is closed for the eight year run. | Public record |
| GUIDE participation | Reported by MedCity News and MobiHealthNews in 2024 and in the August 2024 Pearl Health announcement. CMS publishes its participant list as a spreadsheet, not on the model page; an independent directory built from it counts more than 450 organizations. | Independent |
| “Only CMS GUIDE provider operating in all 50 states” | Stated on the company’s partner pages. Not verifiable from any CMS page reached for this profile. | Company-stated |
| GUIDE outcomes | A 25% reduction in all-cause admissions, 35.8% in inpatient admissions and 19.6% in emergency department visits from baseline. The company says CMS posted its 2025 model outcomes; no CMS document carrying those figures was located. A separate company page gives 19% fewer emergency visits against traditional models, a different comparison. | Company-stated |
| NIH grants | Five NINDS small business awards to Synapticure, Inc.: R44NS124457 (FY2022 $1,171,621, FY2023 $1,003,739), R43NS134458 (FY2023 $499,999) and R44NS143521 (FY2025 $1,253,527, FY2026 $1,246,192). Total $5,175,078. PIs Martina De Majo and Layla Ghaffari. The current award runs to April 30, 2027. | Public record |
| Peer-reviewed papers | Three list the company’s NIH investigators as authors, including a granulin brain organoid study in Stem Cell Reports (March 2023) and TDP43 work in the Journal of Clinical Investigation (September 2025). None on the care model itself. | Public record |
| Registered trials | None under the company name in the records pulled for this profile, though the company describes an IRB approved study in presymptomatic ALS gene carriers from April 2023 and a virtual expanded access program with Clene in 2024. | Not found |
| Patient volume | “Several thousand patients” as of November 2024, more than double the prior year per Entrepreneur. The medical group, CareND, is described as in network with Medicare and various commercial plans, but no health plan contract has been named. | Company-stated |
Read plainly: the payment model is public, the grants are public, the clinical results are not. Every number that would tell you whether this is better care comes from the company. That is normal for a provider this young, and it is the first thing a payer will ask for. GUIDE generates the audit trail that could settle it, because CMS holds the claims.
What to watch
- Whether CMS publishes participant-level GUIDE results confirming the 25% admissions and 19.6% emergency numbers.
- A new Form D or an announced round. The last filing on record is from September 2024.
- Any ClinicalTrials.gov registration for the gene carrier study or the expanded access work.
- Named health plan contracts. CareND’s in-network list is not public.
- Whether the organoid platform earns outside revenue before R44NS143521 ends on April 30, 2027.
In their words
“If you ask 100 patients about the ALS care system today, nearly all will say the hallmarks of the current ALS care system are confusion, fragmentation and resignation.”
Brian Wallach, co-founder, launch release, February 2022 · Company release
“Today, the bench science and understanding of ALS has far outpaced the clinical care provided to ALS patients,”
Sandra Abrevaya, co-founder and CEO, February 2022 · Company release
“When people can’t afford that, their entire life is imprisonment. They are imprisoned as a caregiver.”
Sandra Abrevaya, NPR, June 2023 · Independent
“It doesn’t matter if new therapies get approved if people can’t access the doctors to prescribe them, and if we don’t have a workforce that is prepared to give people really expert guidance on which of these therapies could be a good fit, helping people navigate these treatment decisions.”
Sandra Abrevaya, Entrepreneur, November 2024 · Interview
“Working with Synapticure has saved time for our physicians and staff, allowing us to focus on providing frontline ALS care for our patients,”
Catherine Lomen-Hoerth, MD, PhD, director, ALS Center at UCSF, 2022 launch release · Company release
“But ALS patients still often struggle with access to specialists, diagnostics, and a personalized approach to their care.”
James Berry, MD, chief, ALS and Motor Neuron Diseases, Mass General, 2022 · Company release
“We’re proud to offer care in all 50 states, but that means we’re also navigating the complexities of state-by-state regulations and policies.”
Elizabeth Ferluga, MD, director of movement disorders, NeurologyLive, 2026 · Interview
Related companies
Sources
- Public recordForm D, Synapticure, Inc.
- Public recordForm D, Synapticure SPV I, LLC
- Public recordGUIDE Model overview
- Public recordNIH RePORTER, three NINDS awards
- Public recordGranulin loss of function in brain organoids
- Public recordNemo-like kinase disrupts nuclear import in ALS
- IndependentSynapticure Secures $25M To Scale Virtual Care
- IndependentSynapticure scores $25M to scale its platform
- InterviewHer Husband Was Diagnosed With ALS. Now, Her Company Helps Others Get Care
- IndependentHe was diagnosed with ALS. Then they changed medical advocacy
- InterviewBehind Synapticure’s Newly Expanded Virtual Ataxia Care Program
- IndependentDementia GUIDE Model participant directory
- PartnerSynapticure and the ALS Association Partner to Expand Telehealth Access
- CompanySynapticure and Pearl Health Partner on Dementia Care
- CompanySynapticure Launches With $6M in Seed Funding Led by GV
- CompanySynapticure Raises $25 Million Series A
- CompanySynapticure Launches Ataxia Care Program
- CompanyCMS GUIDE, partners and research pages
- CompanySynapticure’s Origin Story
Profile researched and written by Healthcare Discovery. Last updated September 29, 2026.
